What Drives Friction Between Providers and Payers?
Delayed or denied payment due to avoidable friction between payers + providers is unsustainable and must be addressed. Here are 3 key causes. … Read More
February 10, 2025
Supporting Our Clients Against MA Plans’ 340B Inequities
Providers are being ignored by contracted and non-contracted MA plans in their efforts to obtain a remedy for 340B drug underpayments. … Read More
November 13, 2024
3 Proactive Steps to Counteract Payer Denials and Delays
Receiving accurate, timely reimbursement and reducing unnecessary administrative cost imposed by payers requires a proactive strategy. … Read More
November 5, 2024
Deep Dive: Is Your Practice in the Pre-Payment Review ‘Penalty Box’?
Pre-payment review means you must submit medical records with each affected claim before the payer will agree to pay or adjudicate claims. … Read More
September 6, 2024
What Is a Reference-Based Pricing Plan?
Reference-Based Pricing plans pay based on a benchmark set by an administrator, rather than based on services rendered or value derived. … Read More
May 1, 2024
Payers Are Pushing for Direct EMR Access. Providers Must Push Back.
Since EMR access is so valuable, we encourage providers to take a thoughtful approach before giving it away without an equitable exchange. … Read More
August 9, 2023
The Real Cost of Medicare Advantage Plan Success
Medicare Advantage plans have never cost taxpayers less than traditional Medicare, despite that being the entire goal of the program. … Read More
August 9, 2023